More on a theme
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, FAAD, May 1, 2023
In our February edition of DermWorld, we addressed some of the similarities and differences that should be considered when treating children with biologics, reminding us that kids are not just “little adults.” Turns out this applies to the world of allergic contact dermatitis, which we explore this month in our cover feature. Allergic contact dermatitis in children is, for a variety of reasons, almost certainly an underdiagnosed disorder. Since many children suffer from atopic dermatitis, and both the symptoms and treatments of the two conditions overlap, it is probable that at least some of those diagnosed with eczema have contact dermatitis, and possibly both disorders concurrently. Patch testing, which is necessary to accurately diagnose contact dermatitis, can help distinguish between allergy and eczema. Unfortunately, patch testing is technically challenging in children, whose backs are often too small to accommodate a reasonable number of allergens. Keeping the patches on and having families return to clinic for the multiple visits needed both add to the complexity of the process. And, as our article points out, we need to test with appropriate allergens, since children may be exposed to and develop allergies to different chemicals than adults.
But first, and foremost, we recognize that children can, and do, get allergic contact dermatitis. We need to keep this on our diagnostic radars and develop strategies to get them appropriate testing. We may also need to fight to ensure that our pediatric patients have access to patch testing, as this is a service that may not be covered by some insurers. According to the Kaiser Family Foundation, around 40% of children in the U.S. rely on Medicaid for their health care coverage. As dermatologists, we can engage with decision makers at the state and local level to help them understand why access to care that we uniquely provide can both improve the care our patients receive, as well as potentially save the state money by eliminating inappropriate or unnecessary care. Our Academy has resources and plenty of people who can help you get there, so please reach out if you need help!
This offers me a perfect segue into our next feature article this month on leadership in the house of medicine. We are fortunate as a specialty to have some amazing colleagues who have been active in leadership positions at the highest levels, including our own Academy presidents, to the president of the American Medical Association, and even Acting Surgeon General. We asked some our favorite dermatology leaders to share their insights about leadership, which we share this month In the first of our two-part series. There are many pearls of wisdom in these few pages, which I think you will enjoy reading.
Sometimes, it is just nice to hear about people doing good. Seems we have a lot of them in our specialty! A decade ago, Bob Brodell, MD, FAAD, moved to Mississippi, where he was tasked with improving the dermatologic health of the entire state. He and his team at the University of Mississippi Medical Center established a unique rural dermatology residency program, which may serve as a model for others hoping to increase dermatology access in their states. Several other colleagues who practice dermatology in rural areas share their heartwarming stories about life outside of the “big city” in our feature article on rural medicine. These stories, plus Dr. Cronin’s pick for the Presidential Spotlight, as well as all our other articles that share the good work being done by our fellow dermatologists leave me confident that our specialty is in good hands.
Happy May!
